[French clinical practice guidelines developed by a modified Delphi consensus process for oocyte vitrification in women with benign gynecologic disease]. / Indications de vitrification ovocytaire dans les pathologies gynécologiques bénignes : conseils de bonne pratique du CNGOF après étude de consensus par méthode Delphi.

OBJECTIVES: To provide clinical practice guidelines about fertility preservation (FP) for women with benign gynecologic disease (BGD) developed by a modified Delphi consensus process for oocyte vitrification in women with benign gynecologic disease. METHODS: A steering committee composed of 14 healthcare professionals and a patient representative with lived experience of endometriosis identified 42 potential practices related to FP for BGD. Then 114 key stakeholders including various healthcare professionals (n=108) and patient representatives (n=6) were asked to participate in a modified Delphi process via two online survey rounds from February to September 2020 and a final meeting. Due to the COVID-19 pandemic, this final meeting to reach consensus was held as a videoconference in November 2020. RESULTS: Survey response of stakeholders was 75 % (86/114) for round 1 and 87 % (75/86) for round 2. Consensus was reached for the recommendations for 28 items, that have been distributed into five general categories: (i) Information to provide to women of reproductive age with a BGD, (ii) Technical aspects of FP for BGD, (iii) Indications for FP in endometriosis, (iv) Indications for FP for non-endometriosis BGD, (v) Indications for FP after a fortuitous diagnosis of an idiopathic diminished ovarian reserve. CONCLUSION: These guidelines provide some practice advice to help health professionals better inform women about the possibilities of cryopreserving their oocytes prior to the management of a BGD that may affect their ovarian reserve and fertility. STUDY FUNDING/COMPETING INTEREST(S): The CNGOF (Collège National des Gynécologues Obstétriciens Français) funded the implementation of the Delphi process.

[Familial exudative vitreoretinopathy: our experience]. / Vitreorretinopatía exudativa familiar: nuestra experiencia.

PURPOSE: To describe our experience in the diagnosis of Familial Exudative Vitreoretinopathy (FEVR) at its different clinical stages. We also report our outcomes in early treatment of this inherited disorder. METHODS: Retrospective interventional and descriptive case series of 11 patients (17 eyes) affected by FEVR evaluated and treated in our hospital. RESULTS: In our series, 33.3% of patients were classified as stage I, while 16.7% and 50% were classified as stage II and III, respectively. Visual acuity (VA) remained stable after treatment in stages I and II (mean VA was 0.8 and 0.4, respectively) but decreased in stage III. CONCLUSIONS: Early treatment of FERV may improve the visual prognosis and avoid complications such as subfoveal chronic exudation and vitreoretinal peripheral interphase contraction and fibrosis.

Vitreorretinopatía exudativa familiar: nuestra experiencia / Familial exudative vitreoretinopathy: our experience

Objetivo: Evidenciar la variabilidad de la presentacióninicial de la vitreorretinopatía exudativa familiar(VREF) y la importancia de su diagnóstico ytratamiento precoz. Así como, valorar la respuestaal tratamiento de los diferentes estadios clínicos.Métodos: Realizamos un estudio retrospectivo,intervencional y descriptivo de 11 pacientes (17ojos) afectos de vitreorretinopatía exudativa familiartratados en nuestro centro.Resultados: De los pacientes afectos de vitreorretinopatíaexudativa familiar, un 33,3% se encontrabanen el estadio I, un 16,6% en el estadio II y el50% restante en estadio III.Los resultados tras el tratamiento fueron lossiguientes. En los estadios I y II, la agudeza visualse mantuvo estable (agudeza visual media 0,8 y 0,4respectivamente). En el estadio III se observó unempeoramiento de la agudeza visual.Conclusiones: El tratamiento en estadios inicialespuede mejorar el pronóstico visual y evitar complicacionescomo la exudación subfoveal crónica y lacontracción y fibrosis en la interfase retino vítreaperiférica que pueden provocar ectopia macular

Purpose: To describe our experience in the diagnosisof Familial Exudative Vitreoretinopathy (FEVR)at its different clinical stages. We also report our outcomesin early treatment of this inherited disorder.Methods: Retrospective interventional and descriptivecase series of 11 patients (17 eyes) affected byFEVR evaluated and treated in our hospital.Results: In our series, 33.3% of patients were classifiedas stage I, while 16.7% and 50% were classifiedas stage II and III, respectively.Visual acuity (VA) remained stable after treatmentin stages I and II (mean VA was 0.8 and 0.4, respectively)but decreased in stage III.Conclusions: Early treatment of FERV may improvethe visual prognosis and avoid complicationssuch as subfoveal chronic exudation and vitreoretinalperipheral interphase contraction and fibrosis

[Photodynamic therapy in adult-onset foveomacular vitelliform dystrophy]. / Terapia fotodinámica en distrofia foveomacular viteliforme del adulto.

CASE REPORT: We present the case of a patient who underwent photodynamic therapy (PDT) for adult-onset foveomacular vitelliform dystrophy (AFVD) at another clinic, having been misdiagnosed as having a choroidal neovascular membrane. Two years post-treatment, the patient had severe central visual loss and showed angiographic signs of choroidal hypoperfusion. DISCUSSION: AFVD is a rare clinical entity, usually having a fair visual prognosis, although some cases may show episodes of severe visual loss during their clinical course. Optical coherence tomography (OCT) is valuable in revealing the distinct images of AFVD from the features of a choroidal neovascular membrane. PDT using verteporfin may have negative long term effects if used in patients with AFVD.

Terapia fotodinámica en distrofia foveomacular viteliforme del adulto / Photodynamic therapy in adult-onset foveomacular vitelliform distrophy

Caso clínico: Se describe el caso de un paciente al que se le realizó terapia fotodinámica con Verteporfin (TFD) en una distrofia foveomacular viteliforme del adulto (DFVA) en otro servicio al ser confundido con una membrana neovascular coroidea. La tomografía de coherencia óptica (OCT) es de gran ayuda en el diagnóstico diferencial. El paciente sufrió una disminución de la agudeza visual (AV) severa a los dos años del tratamiento con signos angiográficos de hipoperfusión coroidea. Discusión: La DFVA es una entidad poco frecuente caracterizada por tener un buen pronóstico visual si bien existen casos con limitación de la AV severa en cortos períodos de tiempo en su historia natural. La OCT presenta una imagen claramente diferente respecto a la neovascularización coroidea. La terapia fotodinámica con Verteporfin puede no tener un efecto positivo a largo plazo en pacientes con DFVA

Case report: We present the case of a patient who underwent photodynamic therapy (PDT) for adultonset foveomacular vitelliform dystrophy (AFVD) at another clinic, having been misdiagnosed as having a choroidal neovascular membrane. Two years post-treatment, the patient had severe central visual loss and showed angiographic signs of choroidal hypoperfusion. Discussion: AFVD is a rare clinical entity, usually having a fair visual prognosis, although some cases may show episodes of severe visual loss during their clinical course. Optical coherence tomography (OCT) is valuable in revealing the distinct images of AFVD from the features of a choroidal neovascular membrane. PDT using verteporfin may have negative long term effects if used in patients with AFVD

Actitud frente a los tumores coroideos melanocíticos de pequeño tamaño / Management of small choroidal melanocytic tumors

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[The incidence of second neoplasms in advanced laryngeal cancer. Impact on survival]. / Incidencia de segundas neoplasias en el cáncer de laringe avanzado. Impacto sobre la supervivencia.

BACKGROUND: The incidence of second neoplasms in laryngeal cancer is greater than that of other neoplasms. The appearance of a second neoplasm in these patients represents an important decrease in survival. The prevalence of second neoplasms in laryngeal cancer and its impact on survival was determined in this study. METHODS: Seventy-eight patients with advanced laryngeal cancer (stages III and IV of the UICC) who had been treated with erradicative surgery from January 1984 to December 1988; and who were attended in the Radiotherapy and Oncology Department of the Ciutat Sanitària i Universitària Vall d'Hebron were retrospectively studied. All were postoperatively submitted to radiotherapy. RESULTS: Ten of the 78 patients studied (13%) developed a second neoplasm. The most frequent localization was pulmonary (70%). In 9 of the 10 patients the appearance of the second neoplasm was considered metachronic with 60% being detected within the first 24 months after the diagnosis of the laryngeal neoplasm. The survival of the whole group was 80% at 2 years and 51% at 5 years. Survival of the patients with the second neoplasm was lower: 71% at 2 years and 5% at 5 years (p < 0.0001). CONCLUSIONS: The presence of a second neoplasm in patients with laryngeal cancer is high. The survival of patients with advanced laryngeal cancer who develop a second neoplasm is significantly lower than that of other patients with this neoplasm.

Ureaplasma in semen and IVF.

Ureaplasma urealyticum (U.U.) screening has been systematically performed in tests carried out before IVF cycles. In 42% of the cases (306 couples), at least one partner presented a monomicrobian U.U. infection. U.U. infection of at least one fraction of the split ejaculate was observed in 32% of the cases and found in similar proportions at the prostatic and seminal vesicle levels. The U.U.-infected group presented a similar number of cytological abnormalities to the noninfected samples. However, there was a significant reduction in the pregnancy rate after embryo transfer in the infected group whereas U.U. did not alter fertilization parameters, embryo retrieval or pregnancy rates per puncture. The preliminary results of a complementary prospective study (70 couples) point to the likely role of sexually transmitted Ureaplasma at the endometrial level.

Slide Flask direct amniotic fluid cultures.

Slide Flask direct amniotic fluid culture enabling: to decrease the risk of abnormalities caused by the technique itself, to facilitate laboratory work, to shorten culture time (8 to 13 days).

[Presence of caries and periodontal disease in Spanish students. Overview of results obtained in different localities]. / Presencia de caries y enfermedad periodontal en los escolares Españoles, visión global de los resultados obtenidos en las distintas localidades.

Results of our survey in 11 locations of Spain are assembled in an overview showing percentages of persons according to the highest C.P.I.T.N. code defected for each one, the prevalence of caries-free-children and mean D.M.F.T. scores. We have also studied the differences between urban and rural populations. Rural children presented higher D.M.F.T. an D.T. scores.

Are clinical and biological IVF parameters correlated with chromosomal disorders in early life: a multicentric study.

A multicentric study was carried out to analyse in a large series: (i) the chromosomal status of unfertilized oocytes, (ii) errors at fertilization and (iii) the chromosomal complement of cleaved embryos. Parameters such as type of sterility, maternal age, stimulation treatment, doses of gonadotrophins administered and oocyte preincubation time before insemination were studied in relation to the incidence of chromosome abnormalities. Twenty-six per cent of the unfertilized oocytes and 29.2% of the embryos had chromosome anomalies. Maternal age significantly increased the rate of aneuploidy in oocytes: 38% in patients over 35 years (versus 24% in younger patients). Fertilization-related abnormalities were significant, i.e. 1.6% parthenogenesis and 6.4% polyploidy. Unexplained infertility was correlated with an increase in the rate of parthenogenesis (4.2%) when compared with tubal infertility (1.2%). Triploidy was found to be correlated with three parameters. A lower rate of triploidy was observed in the group of couples referred because of male sterility (1.9% versus 6.3% for tubal sterility), in HMG-treated patients (2.4% versus 7% with analogues of LHRH/HMG) and with a short 2-h preincubation time before insemination (3% versus 7.2% for greater than 2 h). A general model for natural selection against embryos carrying a chromosome imbalance was proposed.

[Acute lymphoblastic leukemia in children. Long survivals obtained with protocols C2-72 and D-74 (1972-1977)]. / Leucemia aguda linfoblástica en niños. Largas supervivencias obtenidas con los protocolos C2-72 y D-74 (1972-1977).

Between 1972-1977, 92 patients with acute lymphoblastic leukemia, between 0 and 14 years of age, were treated with C2-72 and D-74 protocols. Induction treatment consisted of prednisolone (PRED)-vincristine (VCR) with the addition of daunorubicin (prot. C2-72) or asparaginase (prot. D-74). In both protocols, preventive therapy on the CNS consisted of cranial irradiation (24 Gy) and 5 doses of methotrexate i.t. (MTX). For the maintenance phase in protocol C2-72, three combinations: mercaptopurine (MP)-MTX, MP-Ara.C and MTX-cyclophosphamide, were sequentially administered for 3 years, with reinductions of PRED-VCR every three months. In protocol D-74, only MP-MTX was used for 3 years; the random half of the patients also received "reinductions". In protocol C2-72, BCG was administered by scarifications for 2 years to patients in remission after 36 months; in D-74, the random-half patients received BCG and irradiated allogeneic blasts for one year. The other half of the patients received no other treatment. The overall disease-free survival rate is 45.6% with a duration of between 84 and 156 months. Only one death occurred after 7 years. In protocol C2-72, 9 of 26 initial patients (34.6%) and in protocol D-74, 33 of 66 initial patients (50%) are still alive, off treatment and with no sign of disease. Ten patients (10.8%) died in continuous remission of infection (8) or toxic encephalopathy (2); five deaths were caused by "Pn. carinii". The incidence of meningeal relapse was 11% and isolated testicular relapse in males 15.7%; moreover, in 6 of the 22 boys in remission, programmed testicular biopsy showed interstitial leukemic infiltrates. Analysis of initial risk factors permitted the establishment of a risk index (r.i.): in cases with a r.i. below 3 (76% of cases) the survival rate was 53%; in the group with a higher r.i. (24%), it was 22%. Further conclusions of this study were: the lack of effectivity of "reinductions" and immunotherapy and proof of a higher rate of relapses in males mainly owing to isolated testicular relapse.

[Treatment of high and low risk acute lymphoblastic leukemias in the child, with 2 modalities of preventive therapy on the central nervous system (Pethema 7/78 protocol)]. / Tratamiento de las leucemias agudas linfoblásticas de alto y bajo riesgo en el niño, con dos modalidades de terapéutica preventiva sobre SNC. (Protocolo Pethema 7/78).

More effective therapy of high-risk patients and less toxic CNS prophylaxis are two goals in present acute lymphoblastic leukemia treatment research. Protocol LA A 7/78 was based on: 1) Distribution of patients in 2 therapy groups: standard (SR) and high-risk (HR) according to presence of clinical and hematological prognostic factors. 2) Remission induction in SR with PRED, VCR and ASPAR, and as maintenance, combination of MP and MTX. HR patients were given 4 drugs, with addition of DAUNO; reinductions with PRED, VCR and DAUNO every 3 months were given as well. 3) CNS prophylaxis in both groups was given according two modalities, on a randomized base. "A": cranial irradiation (24Gy) plus i.t. MTX, 6 doses. "B": i.t. MTX and ARA-C, 10 doses (6 weekly and 4 monthly). From 1978 to 1983, 76 patients under 14 years old were entered in study: 22 in HR and 54 in SR groups. All attained remission. After a median follow-up of 49 months estimated disease-free survival rate is 65.6% corresponding to 70% in SR and 56% in HR. Modality "B" of SNC prophylaxis (without irradiation) was, at least, as effective as modality "A" in SR and HR groups; estimated disease free survival is 60.5% +/- 9% in "A" and 71 +/- 8.5% in "B" therapy. Mortality by infections in patients in remission was less than 4%. This low proportion can be attributed in part to continuous use of cotromoxazol. Main conclusions of this study are: 1. Need for more intensive induction and consolidation therapy, especially in high-risk patients, and 2. That prolonged (5 months) intrathecal chemotherapy can substitute cranial irradiation in CNS prophylaxis.